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[Suppurated pneumococcal meningitis in infants and children: complications and prognostic factors]
J L Pesso1, D Floret, P Cochat
1Unité de réanimation pédiatrique, Hôpital Edouard-Herriot, Lyon, France.
Insights
Pneumococcal meningitis is a severe disease. Intracranial pressure monitoring in severe cases can improve patient outcomes by managing intracranial hypertension, a frequent complication.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Context:
- Pneumococcal meningitis is a significant cause of morbidity and mortality in children.
- Severe forms of the disease often lead to serious complications.
- Intracranial hypertension (IH) is a common and dangerous complication.
Purpose:
- To investigate the role of intracranial pressure (IP) monitoring in managing pediatric Pneumococcal meningitis.
- To assess the relationship between IH and neurological complications, outcomes, and mortality.
- To evaluate the effectiveness of IP monitoring in severe cases.
Summary:
- This study analyzed 21 patients with Pneumococcal meningitis, focusing on severe cases and the impact of intracranial pressure (IP) monitoring.
- Intracranial hypertension (IH) was observed in 7 monitored patients, correlating with severe outcomes and neurological complications like cerebral edema and coning.
- While 12 children had favorable outcomes, 7 experienced sequelae, and 2 died from coning, highlighting the disease's severity and the potential benefit of IP monitoring.
Impact:
- IP monitoring appears crucial for managing IH, a primary driver of complications and poor prognosis in severe Pneumococcal meningitis.
- Early detection and management of IH through monitoring can potentially improve neurological outcomes and reduce mortality.
- Findings underscore the need for vigilant monitoring and management strategies for intracranial pressure in pediatric meningitis cases.
Abstract:
This paper investigates 21 patients (16 infants and 5 children) with Pneumococcal meningitis, 15 of which presented with a severe form. Intracranial pressure (IP) monitoring was performed in 7 patients who all had severe (4) or mild (3) intracranial hypertension (IH). Twelve children had a favourable outcome, 7 had sequelae (3 severe) and 2 died from coning, one before monitoring, the second after exhibiting the highest IP and the lowest cerebral perfusion pressure of the series. The 3 children with severe sequelae had a severe form (2) or a mild but prolonged form (1) of IH. The 4 patients who recovered with moderate sequelae presented severe (1), mild IH (1) or were not monitored (2). There were 14 cases with neurological complications. In 8 patients, this seemed to be related to cerebral oedema and IH; coning caused the death of 2 of them; the 6 others exhibited lesions of cerebral oedema on CT-scan, isolated or associated with cerebral infarction or subdural effusion. In the 6 others patients, IP monitoring was not performed; there was no evidence of cerebral oedema on CT-scan; 2 exhibited cerebral infarction and 3 a moderate ventricular dilatation; 2 had hemodynamic problems from acute pneumococcemia in one case and neurovegetative disturbances associated with cerebral infarction in the second. Pneumococcus meningitis remains a severe disease. The prognosis of severe forms can be improved by IP monitoring since IH seems to be the most frequent mechanism of complication.